P1673: UNEMPLOYMENT IN ADULT SURVIVORS OF ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANT IS ASSOCIATED WITH OLDER AGE, GRAFT VERSUS HOST DISEASE, HIGH PHYSICAL SYMPTOM BURDEN, AND IMPAIRED QUALITY OF LIFE
Authors: Genevieve Douglas, Eric Wong, Teresa Garcia, Ritchie David, Yvonne Panek-Hudson
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: Allogeneic haematopoietic stem cell transplantation (alloHSCT) may improve survival outcomes for some haematologic malignancies, but negative impacts on longer-term quality-of-life are common, including reduced employment and financial toxicity. Identifying predictive factors for such outcomes may assist with pre-alloHSCT counselling, and patient/carer preparedness for potential challenges. Access to support varies regionally, and local data is required to inform local practice. There is a paucity of Australian data in this context. Aims: 1.Identify factors associated with unemployment 2-5 years post alloHSCT, in a local alloHSCT cohort, which may assist in pre-alloHSCT planning 2.Examine impact of unemployment on quality-of-life outcomes and financial stress, and identify differences in symptom burden for employed versus unemployed patients Methods: We performed a retrospective analysis of alloHSCT recipients with malignant haematologic diseases at the Royal Melbourne Hospital (RMH) transplanted from 2009 – 2020 and reviewed in the long-term follow-up (LTFU) clinic 2-5 years post alloHSCT. Data included sociodemographic, clinical, employment status, and quality-of-life surveys (FACT-G, FACT-BMT, EORTC-QLQ-C30, FACIT-F). Descriptive and inferential statistics were conducted using SPSS (version 28.0.1.1 (15)) utilising chi-square analysis and Mann-Whitney U testing to identify group differences, with a significance level (α)=0.05. Results: 267 patients (43% AML, median age 49 years, 40% female) transplanted between 2009-2010 were reviewed in the LTFU at 2-5 years post alloHSCT (see table 1). Employment rates pre-transplant were 77%, and 64% in the 2-5-years after transplant, with no change over time. Factors significantly associated with post-transplant unemployment included pre-transplant unemployment (p<0.001), with only 26% of such patients employed post alloHSCT. Others were older age (p<0.001), particularly >50 years, CMV serostatus (p=0.003), acute or chronic GVHD history requiring immunosuppression (p=0.003, p = 0.02 respectively), and haploidentical donor (p=0.013). No associations were seen for conditioning intensity, transplant indication, ATG use, or relapse prior to LTFU review. Pre-alloHSCT, females were less likely employed than males (P=0.003), but following alloHSCT, sex was not associated with employment status. Education level was not associated with pre-transplant employment status (P=0.718), but tertiary education was associated with employment post-transplant (P<0.001), suggesting challenges securing post alloHSCT employment for those without tertiary education. Unemployment post-transplant was significantly associated with reduced QoL as measured by FACT-BMT (p<0.001), EORTC-QLQ-C30 (p<0.001) and associated functional/ wellbeing scales. Symptom burden (fatigue, pain, dyspnoea, low appetite, and constipation) were significantly increased in unemployed survivors, as was financial stress (p<0.001). Summary/Conclusion: Unemployment post-alloHSCT is associated with poorer quality of life, high symptom burden and financial burden. Pre-transplant factors including age>50 and non-tertiary education should be considered as risks for longer term unemployment, with negative impacts of recipient CMV (pos) serostatus and use of a haploidentical donor. These factors will be useful, particularly within an Australian context, in advising patients as to the long-term quality of life impact of alloHSCT.Keywords: Allogeneic hematopoietic stem cell transplant, Quality of life, Adult, Age